1336245323 NPI number — MICHAEL N BAAKO MD

Table of content: MICHAEL N BAAKO MD (NPI 1336245323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336245323 NPI number — MICHAEL N BAAKO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAAKO
Provider First Name:
MICHAEL
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336245323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20914-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-295-0502
Provider Business Mailing Address Fax Number:
240-295-0503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 FORT MEADE RD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20724-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-295-0502
Provider Business Practice Location Address Fax Number:
240-295-0503
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0057216 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: C1-0006365 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8107145/ 2107145 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 667490 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7457439 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0404202 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5455054 . This is a "CCN NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: H816-0001 . This is a "BCBS NATIONAL CAPITAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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